71046
Chest x-ray, 2 views
Radiologic examination of the chest, two views (PA and lateral). The most ordered imaging study in U.S. medicine. CMS 2026 global wRVU 0.22, total RVU approximately 0.89, Medicare global allowable approximately $30 at the national-GPCI conversion factor. Modifier 26 (professional component only) drops the practice-expense portion; modifier TC reports the technical component only.
When to use it
Use 71046 when both a frontal (PA or AP) and a lateral image are acquired, which is standard for non-portable chest imaging. Common indications: cough or dyspnea workup, low-suspicion chest pain (when ACS is not leading), hemoptysis, pulmonary nodule follow-up, pre-operative clearance, blunt thoracic trauma screening.
Full guidance
Use 71045 for a single view (typical of portable AP supine), 71047 for three views (often added rib obliques), 71048 for four-plus views (dedicated rib series, detailed apical survey). Pick by total views actually obtained on the encounter, not by clinical question.
Documentation checklist
- ✓Indication on the order: cough, dyspnea, pleuritic chest pain, follow-up of known finding, pre-op evaluation, etc. "Chest x-ray" without indication is denied as medical necessity not established.
- ✓Views obtained must match the code: 71045 (1 view), 71046 (2 views), 71047 (3 views), 71048 (4+ views).
- ✓Interpretation report covers lung fields, mediastinum, cardiac silhouette, bony thorax, soft tissues, plus comparison to prior imaging where available. Signed and dated.
- ✓Setting determines the modifier: hospital outpatient = 26 (professional only), freestanding imaging center with owned equipment + interpretation = global, IDTF billing technical = TC.
- ✓Repeat imaging within the same encounter: modifier 76 (same physician) or 77 (different physician) on the repeat code.
Common pitfalls
- !Setting-modifier mismatch. A hospital-employed radiologist billing global instead of 26 is a recurring overpayment audit target.
- !View-count miscoding. Billing 71046 (2 views) when only one supine portable AP was obtained should be 71045.
- !Missing indication on the order. "Routine" is not a covered indication for screening CXR; use a clinical reason.
- !Billing 71046 alongside the screening lung CT (low-dose chest CT for tobacco screening, G0297 or 71271). The chest x-ray bills separately only with a distinct clinical indication.
- !Confusing portable AP single view (71045) with the standard PA + lateral (71046). Portable bedside CXRs in ICU/ED are routinely 71045.
Payer notes
Medicare covers 71046 with no prior authorization. Medicare Advantage typically follows but some plans require prior auth above an annual frequency threshold for the same patient. Commercial payers generally cover; some commercial plans require the CXR to be paired with an E/M on the same date. Annual screening CXR is not a covered Medicare benefit (use a clinical indication); commercial wellness plans may cover annual screening with specific employer riders.